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2. Bedford Connection Newsletter Coupon Form

   Submit a coupon for your business that will be included in future Bedford Connection Newsletter issues. The submission of coupon information does not guarantee inclusion in the publication. Please keep in mind that the coupon sheet is sent to the printer prior to the beginning of the month of publication. Businesses that submit coupons must offer products and services to its customers face-to-face in an office or store that the business owns or rents.

4. Business Name*
6. Name*
7. Email Address*
9. Business Address*
   Provide the address for your business located in the City of Bedford.
11. City*
12. Zip Code*
14. Business Phone Number*
    Provide the phone number for your business located in the City of Bedford.
15. Fax Number
17. Logo*
    Please submit a high-quality company logo.
18. Website*
    Provide the website for your business located in the City of Bedford.
20. Desired Publication Month*

    Please select the month(s) you’d like your coupon to appear in the Bedford Connection. Please keep in mind that coupon sheets are finalized the month before they are published and mailed out. I.E., if you are submitting for December publication, please submit by the beginning of November. Selecting a month does not guarantee inclusion into the publication.

    1. First Available
    2. January
    3. February
    4. March

    1. April
    2. May
    3. June

    1. July
    2. August
    3. September

    1. October
    2. November
    3. December
22. Coupon Information*
    Please enter the desired information to be listed on the coupon.
24. Expiration Date*
    Expiration Date
    Please enter the desired date of expiration for the coupon.
25. Coupon Redemption*

    Designate the methods for which customers may redeem your coupon. Keep in mind that only accepting print coupons will limit the opportunity for customers to redeem your offer.

    1. Digital and Print
    2. Print Only (Coupon Required)
27. Disclaimer*

    1. By checking this box, I affirm that all information submitted is correct and grant the City of Bedford permission to utilize all submitted images and information online and in print.
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field